In 1978, the first baby conceived by In vitro fertilisation (IVF) was delivered. Since then the demand for Assisted Reproductive Technology (ART) has increased. In most countries 1-5 per cent of babies are conceived through IVF.
Although majority of patients have normal outcomes, a significant minority does not. Assisted conceptions are at an increased risk of maternal and fetal complications but it is not clear whether this is the consequence of the ART procedures or of the innate characteristics of the women who undertake these treatments.
The complications can be divided into:
Early pregnancy complication
Ovarian Hyper Stimulation Syndrome – this causes increase in stimulated follicle number and size. This condition can vary from mild to a serious condition requiring ICU admission.
Miscarriage – 15-20 per cent women experience this.
Ectopic Pregnancy – 1.4 per cent of women should have access to specialist counsellors before, during and after ART.
Maternal complications
This is mostly common in older women, over 35 years of age, or in women with high BMI (over 30kg/m2), with polycystic ovaries, and in multiple pregnancies as well as in pregnancies that are created from oocyte, sperm or embryo donation.
Pregnancy with hypertension/ pre-eclampsia increases risk of complications by 2 per cent.
Gestational diabetes increases risk by 1 per cent.
Chances of venous thromboembolism is the highest in the first trimester.
Fetal complications
30-40 per cent increased risk of structural abnormalities, while the absolute risk is still low – 6.5-7 per cent versus 5 per cent
Fetal growth restriction – In IVF, this is a minor risk factor
Stillbirth – Perinatal mortality increases 2.4 fold
Preterm delivery – Before 37 weeks – 11.2 per cent; Before 32 weeks – 2.6 per cent
Placental complications
Placental previa/ Accreta
No additional surveillance is recommended for this
Placental abruption
Vasa previa - If low lying placenta is diagnosed during anomaly scan, transvaginal ultrasound with colour doppler should be undertaken to exclude vasa previa.
It is critical to be aware of these risks before undergoing a fertility treatment. Assisted conceptions can be managed in the same way as spontaneous pregnancies. A thorough risk assessment is imperative, since many women undergoing ART have additional risk factors that necessitate increased monitoring.
— The writer is Specialist, Obstetrics & Gynaecology, Thumbay University Hospital, Al Jurf, Ajman
